الفهرس 
CLINICAL IMPLICATION OF VITAMIN DOnly 14 pages are availabe for public view
 |  | from | 155 |  |  |
| | | from | 155 | | |
Abstract
V
itamin D has pleiotropic functions. It is widely recognized to have a central role in calcium metabolism and bone mineralization. Vitamin D is also physiologically important for the proper function of organs such as skeletal muscle, heart, brain, and pancreas.
Vitamin D may also be implicated in innate and acquired immunity, it could increase innate defense and modulate the activation of lymphocytes implicated in the immune response, leading to a switch toward a T helper 2.
The frequent lack of vitamin D in cirrhotic patients has been known for a long time and could be partly due to liver insufficiency (which could decrease the rate of hydroxylation of cholecalciferol) and cholestasis (which impairs the absorption of fat-soluble vitamins).
As bacterial infections are frequent and are the cause of morbidity and mortality in patients with cirrhosis, many researchers hypothesized that the relationship between the lack of vitamin D and the increase in mortality observed in patients with cirrhosis because of an increase of bacterial infections.
Spontaneous bacterial peritonitis (SBP), an infection of ascitic fluid without demonstrable intra-abdominal cause, is a complication of cirrhosis, with a reported mortality of 20% to 40% in adults.
This study is a cross-sectional cohort study to assess the 25-OH vitamin D serum level in cirrhotic patients and its relation to spontaneous bacterial peritonitis.
It was conducted in the Internal Medicine Department, Ain Shams University hospital in the period from May 2017 to June 2018.
This study included number of (90) Egyptian cirrhotic patients. They were divided into main three groups; group 1; Compensated liver cirrhosis proved by child A score with comparable age liver function (30 patients) group 2; Decompensated liver cirrhosis with ascites with no evidence of spontaneous bacterial peritonitis (30 patients) group 3; Decompensated liver cirrhosis with ascites and spontaneous bacterial peritonitis (SBP) (30 patients).
All the studied patients were subjected to the following: careful medical history taking, full physical examination, and laboratory investigations including CBC, liver function tests, coagulation profile and serum 25-OH vitamin D. Abdominal ultrasonography & CT scan for HCC cases were done.
The results revealed decrease level of 25-OH vitamin D in all studied groups.
Concerning serum level of 25-OH vitamin D; It revealed statistical highly significantly difference between group I (compensated cirrhosis) & group II (decompensated cirrhosis without SBP) being lower in group II, and there also a statistical highly significantly difference between groups II & III being lower in group III. So, serum 25-OH vitamin D levels decrease in cases of liver cirrhosis and is closely related to the progression of liver disease especially in the presence of SBP.
HCC is highly significantly increased in cirrhotic patients with SBP (group III) (P>0.01).
• Concerning to HB, there was a statistically significant difference between groups I & III and groups I & II with more reduction in HB in group III than group I & group II.
• Concerning to WBCs, there was a statistically significant difference between groups I & III and groups II & III with increase WBCs in group III reflecting bacterial infections in ascitic fluid.
• Concerning to PLT, there was a statistically significant difference between groups I & III and between groups II & III.
• Regarding serum ALT, there was a statistically significant difference between groups II & III.
• Regarding serum AST, there was a statistically significant difference between groups I & III and groups II & III.
• Regarding serum Albumin, there was a statistically significant difference between all groups and each other with more reduction in group III.
• Regarding serum total Bilirubin, there was a statistically significant difference between all groups and each other.
• Regarding serum direct Bilirubin, there was a statistically significant difference between all groups and each other.
• Regarding INR there was a high statistically significant difference all studied groups and each other.
• Ascitic neutrophil show a high statistically significant differences between groups II & III (P>0.01) being higher in group III.
• Ionized calcium show no significant differences between studied groups (P<0.05).
• Regarding serum AFP, there was a statistical significant difference between patient with HCC and patient without HCC (P>0.01).
Regarding Serum Vit D versus HGB, WBCs, AST, Alb, T. Bil, D. Bil, INR, AFP, Ascetic neutrophil there is statistically significant difference in all groups reflecting correlation between low Vitamin D and different laboratory liver function tests.